Background. In breast cancer (BC) patients, axillary management has undergone major improvements over the last few years, and efforts to identify the optimal strategy for the management of axillary surgery are still ongoing. Methods. In current clinical practice, women with clinically node-positive (cN+) BC usually receive neoadjuvant chemotherapy (NACT) with the aim of reducing the extent of primary disease and, thus, allowing for axillary-conservative surgery. Remarkably, after NACT, up to one out of three patients achieves an axillary pathologic complete response, which, in turn, is associated with a more favorable prognosis than residual axillary disease. However, NACT is not without drawbacks, as NACT-associated inflammation can damage lymphatic vessels. Furthermore, varying degrees of response may occur in the axillary lymph nodes, increasing the false negative rate for sentinel biopsy. Results. At present, there is no consensus on the optimal approach in patients with cN+ BC undergoing NACT, although multidisciplinary management seems to be recommended. Conclusions. This narrative review provides a comprehensive overview of axillary management in cN+ BC patients undergoing NACT. It uses a multidisciplinary approach that encompasses the oncological management perspectives, as well as surgical and chemotherapeutic viewpoints.
背景：近年来，乳腺癌患者的腋窝处理方式已取得重大进展，但针对腋窝手术最佳管理策略的探索仍在持续。方法：当前临床实践中，临床淋巴结阳性乳腺癌患者通常接受新辅助化疗，旨在缩小原发肿瘤范围，从而为实施保留腋窝功能的手术创造条件。值得注意的是，约三分之一患者在新辅助化疗后达到腋窝病理完全缓解，该状态相较于残留腋窝病灶往往预示着更良好的预后。然而新辅助化疗亦存在局限性，其引发的炎症反应可能损伤淋巴管结构。此外，腋窝淋巴结可能出现不同程度的治疗反应，导致前哨淋巴结活检假阴性率升高。结果：尽管多学科综合诊疗模式受到推崇，目前对于接受新辅助化疗的临床淋巴结阳性乳腺癌患者，尚未形成统一的最优治疗方案共识。结论：本综述系统阐述了接受新辅助化疗的临床淋巴结阳性乳腺癌患者的腋窝管理策略，采用融合肿瘤学管理、外科学及化学治疗视角的多学科研究方法进行全面分析。
肿瘤(癌症)患者之家